| Background:HSP belongs to the category of februarine diseases.Chao Yuanfang in sui Dynasty recorded in The Treatise on Various Diseases:"The disease of spot toxin is the hot gas into the stomach,and the stomach is the main muscle,the heat contained in the stomach,the gas fume the muscles,and the red spot arises." Therefore,this disease is closely related to Yangming heat retention.The incidence and recurrence rate of HSP in children are higher than those in adults.People are closely related to the gastrointestinal heat accumulation of Yangming in children.The spleen is often deficient in children,and when the diet is improper,it is easy to cause gastrointestinal accumulation heat,and become purpura.Repeated attacks of HSP in children not only affect the physical and mental health of children,is also a difficult problem for doctors,so it is necessary to actively explore the factors of recurrence,take intervention measures to reduce the recurrence of the disease.The pathological changes of HSP are caused by the deposition of immune complexes dominated by IgAl on the walls of small blood vessels immune inflammatory response.Gut microbes influence IgA production,transformation,and biological activity and are involved in allergic violet Immune inflammatory response to blebs.Previous studies have shown that Yangming gastrointestinal heat leads to disturbance of intestinal flora in rats,destroying intestinal immunity and mechanical barrier,so whether Yangming accumulated heat affects the pathogenesis of HSP through intestinal flora,further research is needed.Objective:To explore the effect of Yangming heat retention syndrome on the pathogenesis of HSP in children,and to explore Yangming heat retention from the perspective of evidence-based science the correlation with the recurrence of HSP in children,and to explore the risk factors affecting the recurrence of HSP,in order to take corresponding interventions to prevent the occurrence and recurrence of the disease.By studying the intestinal Changes in intestinal flora,try to explore the possible pathogenic mechanism of Yangming heat retention from the intestinal flora.Methods:Study 1:Using a cross-sectional study method,515 children with HSP were included to collect basic information,clinical symptoms,laboratory indicators and the score of Yangming heat retention.According to whether they had Yangming heat retention syndrome,they were divided into Yangming heat retention group(154 Cases)and non-Yangming heat retention group(361 cases),to compare the differences between the two groups.The correlation between Yangming heat retention score and clinical symptom relief was analyzed.Study 2:Using a prospective cohort study method,a total of 272 children with HSP were included in this study.They were divided into Yangming heat retention group(120 cases)and non-Yangming heat retention group(152 cases).The patients were followed up for 6 months.The recurrence rate of HSP was compared between the two groups.And screen the risk factors affecting the recurrence of the disease.Study 3:Using high-throughput sequencing technology,HSP children(20 cases in the Yangming heat retention group and 20 cases in the non-Yangming heat retention group)16sDNA sequencing of fecal flora of 20 cases of healthy children and Lefse analysis,SPSS and other software.The differences in intestinal flora were analyzed and compared,and functional genes were predicted.To investigate the correlation between Yangming heat retention and intestinal microflora.Results:Study 1:1.Compared with the non-Yangming heat retention group,there were more boys in the HSP Yangming heat retention group,and the proportion of gastrointestinal bleeding was significantly higher increased,C-reactive protein,interleukin-1β,interleukin-5 were significantly increased,and y-interferon was significantly decreased.The proportion of blood increased in Yangming heat retention group.2.In the Yangming heat retention group,the swollen part of the intestinal wall was mainly the duodenum,in non-Yangming heat retention group was dominated by jejunum and ileum,and the difference was significant.Logistic regression analysis showed that gastrointestinal bleeding,Interleukin-1β,interleukin-5,duodenal swelling,j ejunum swelling,and ileal swelling were all significantly associated with Yangming heat retention.Among them,j ejunum swelling and ileum swelling were negatively correlated withYangming heat retention,and the others were positively correlated.3.Spearman Correlation analysis showed that the improvement of Yangming heat retention score was associated with the time of abdominal pain relief(rs=-0.347,P=0.019),the time of rash subsided(rs=-0.395,P=0.017).Study 2:1.A total of 272 children with HSP were included,78 cases(26.8%)recurred,including 33 cases in the non-Yangming heat retention group(21.7%),45 cases(37.5%)in the Yangming heat retention group,there was a significant difference between the two groups.The recurrence rate of HSP in the Yangming heat retention group was approximately 2.042 times that of the non-Yangming heat retention group(OR=2.042,95%CI 1.145-3.645,P=0.016).2.Multivariate logistic regression analysis showed that HSP recurrence was associated with Yangming heat retention(OR=1.799,95%CI 1.083-2.987,P=0.023),repeated initial onset rash(OR=2.219,95%CI 1.261-3.902,P=0.006),no dietary restriction after initial cure(OR=2.628,95%CI 1.531-4.511,P<0.001),and recurrent respiratory tract infection after initial cure(OR=3.248,95%CI 1.572-6.711,P=0.001).Study 3:1.There were significant differences in the analysis of diversity and Beta diversity and OUT clustering between Normal children group,HSP Yangming heat retention group and HSP non-Yangming heat retention syndrome group.There was no significant difference between the two groups in HSP.2.There were differences in Verrucomcrobia,Oscillospirales,Rumenobacteriaceae,Faecalibacterium,Bacteroides coprocola,Bacteroidetes vulgaris,and Clostridium butyricum between the three groups.There were differences in verrucomicrobia,Bacteroides coprocola and Bacteroides between between the two groups of HSP.3.Lefse analysis showed that Lactobacillus,Streptococcus,Streptococcus,Lachnoclostridium,The metagenome and Clostridium butyricum were enriched in the HSP with Yangming heat retention syndrome group.4.In the functional prediction of the microbiota,the differences among the three groups were the pathways of ascorbic acid and alginate metabolism,arginine and proline metabolism,thiamine metabolism,and endocytosis.There were significant differences in the endocytosis pathway between the two groups of HSP.5.Spearman correlation analysis showed that the score of heat accumulation in Yangming was negatively correlated with Akemenia,Bacterium_IC1391 and Prevorella.There was negative correlation between C-reactive protein and Ackermania.Interleukin-1β was negatively correlated with Prevotella.Multiple linear regression analysis showed that Yangming heat retention had significant effects on Ackermann(B=-1.08,T=-2.14,P=0.041).Conclusion:1.Children with HSP Yangming heat retention syndrome were more likely to have the syndrome of bleeding due to blood heat,higher risk of gastrointestinal bleeding,more obvious immune imbalance,Yangming heat retention syndrome might be related to the occurrence of sever HSP.2.Children with HSP Yangming heat retention syndrome had a higher risk of recurrence.The recurrence of HSP was associated with Yangming heat retention syndrome,repeated rash at the first onset,no dietary restriction after the first cure,and repeated respiratory tract infection after the first cure.3.The abundance of intestinal flora in HSP children was lower than that in normal children.There were differences in the flora between the two groups of children with HSP.The beneficial bacteria producing short-chain fatty acids in the intestinal flora of the children with Yangming heat retention syndrome decreased and the pathogenic bacteria increased,which may affect the pathogenesis of HSP. |
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